GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF PERMITS STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 FINAL ELECTRICAL INSPECTION REQUEST (Please Print Clearly) LEGAL INFORMATION DATE: NAME OF OWNER: CONTACT NUMBER: ______________________________________________________________________________ LOCATION OF BUILDING: USE OF BUILDING: ☐ RESIDENTIAL ☐ COMMERCIAL ☐ INDUSTRIAL ☐ OTHER NUMBER OF APARTMENTS: NAME OF CONTRACTOR: NAME OF ELECTRICIAN: V.I. LICENSE NO.: ELECTRICAL PERMIT NO.: DATE ISSUED: GENERAL DESCRIPTION TYPE OF FLOOR: WALLS: ROOF: ESTIMATED CURRENT: AMPS VOLTAGE: SERVICE ENTRANCE SIZE: TYPE: ☐ SINGLE-PHASE ☐THREE-PHASE NO. OF DISTRIBUTION PANELS: NO. OF METERS: CIRCUIT DISTRIBUTION NO. OF 120v CIRCUITS: NO. OF 240v CIRCUITS: NO. OF 208v CIRCUITS: TOTAL NO. OF CIRCUITS: FINAL ELECTRICAL INSPECTION CERTIFICATION OF SUPERVISION UPON APPLICATION FOR A CERTIFICATE OF USE AND/OR OCCUPANCY. …
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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF PERMITS STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 FINAL ELECTRICAL INSPECTION REQUEST (Please Print Clearly) LEGAL INFORMATION DATE: NAME OF OWNER: CONTACT NUMBER: ______________________________________________________________________________ LOCATION OF BUILDING: USE OF BUILDING: ☐ RESIDENTIAL ☐ COMMERCIAL ☐ INDUSTRIAL ☐ OTHER NUMBER OF APARTMENTS: NAME OF CONTRACTOR: NAME OF ELECTRICIAN: V.I. LICENSE NO.: ELECTRICAL PERMIT NO.: DATE ISSUED: GENERAL DESCRIPTION TYPE OF FLOOR: WALLS: ROOF: ESTIMATED CURRENT: AMPS VOLTAGE: SERVICE ENTRANCE SIZE: TYPE: ☐ SINGLE-PHASE ☐THREE-PHASE NO. OF DISTRIBUTION PANELS: NO. OF METERS: CIRCUIT DISTRIBUTION NO. OF 120v CIRCUITS: NO. OF 240v CIRCUITS: NO. OF 208v CIRCUITS: TOTAL NO. OF CIRCUITS: FINAL ELECTRICAL INSPECTION CERTIFICATION OF SUPERVISION UPON APPLICATION FOR A CERTIFICATE OF USE AND/OR OCCUPANCY. TO: The Commissioner of Planning & Natural Resources (through the Division of Permits) FROM: Certifying Electrical Supervisor of construction mentioned below SUBJECT: CERTIFICATION OF SUPERVISION AND TRADE WORKMANSHIP LEGAL DESCRIPTION NAME OF OWNER: LOCATION OF BUILDING: ELECTRICAL PERMIT NUMBER: DATE ISSUED: I hereby certify that the above-mentioned project has been built under my supervision and that in its construction all the provisions of the V.I. Building Code and all other applicable laws are complied with. Also, the work done complies with the work proposed on the Electrical Permit as per V.I. Code, Title 29 Chapter 5, §294 © and §298 (b), the latest edition of the National Electrical Code, and all applicable codes. NAME OF CERTIFYING SUPERVISOR: (Electrician, Electrical Contractor, Master Electrician) (Print) SIGNATURE: DATE: Certifying Supervisor PLEASE SIGN AND SEAL THIS CERTIFICATION FORM: Seal and Signature of USVI Licensed Electrician SIGN